Wk8 Consent In Adults Flashcards
What process must people go through to make decisions?
- Gathering information
- Recalling and pooling that information
- Weighing things up
Why might decisions be affected?
- You weren’t competent to make it
- You were coerced, or put under pressure to make the decision too quickly
- You were deceived, or had information concealed from you
What is autonomy?
The idea that a patient must give consent to a treatment derives directly from the notion of patient autonomy
Human beings have the absolute right to make their own decisions about issues that affect them
What principles make up autonomy?
Self determination
Personhood
Identity
Integrity
Autonomy and identity
Autonomy can be considered as the ability to define the self through ones choices It is therefore strongly linked to identity - who someone is
Autonomy is the ability to live according to our own values and beliefs
As such, limiting someone’s autonomy is likely to impinge on someone’s sense of self and lead to a significant emotional reaction
What is the self determination theory?
deals with human motivation and links wellbeing, satisfaction and performance to autonomy, competence, and relatedness
What is autonomy definition?
The idea that a patient must consent to a treatment derives directly from autonomy
Human beings have the absolute right to make their own decisions about issues that affect them
The role of the doctor in the partnership is to help their patient make the best choices possible
Define benevolent concealment
The doctor knows best - would conceal patients information
What are the GMCs 7 key principles of consent?
● All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
● Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
● All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.
● Doctors must try to find out what matters to patients so they can share relevant information
about the benefits and harms of proposed options and reasonable alternatives, including the
option to take no action.
● Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care.
● The choice of treatment or care for patients who lack capacity must be of overall benefit to them
● Patients whose right to consent is affected by law should be supported to be involved in the decision-making process
What is a material risk?
The test of materiality :
- whether a reasonable person in the patient’s position would attach significance to the risk OR
- If the doctor knows (or should know) that this particular patient would attach significance to the risk
GMC guidance on consent
You must give patients clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action.
It wouldn’t be reasonable to share every possible risk of harm, potential complication or side effect. Instead, you should tailor the discussion to each individual patient, guided by what matters to them, and share information in a way they can understand.
● Recognised risks of harm that you believe anyone in the patient’s position would want to know
● The effect of the patient’s individual clinical circumstances on the probability of a benefit or harm occurring.
● Risks of harm and potential benefits that this patient would consider significant for any reason.
● Any risk of serious harm, however unlikely it is to occur.
● Expected harms, including common side effects and what to do if they occur.
Is consent always valid?
Consent can expire - after a prolonged time, or if the situation changes
Consent can also be invalid if certain conditions weren’t met, or if it was given in the wrong way.
For consent to be valid, our decision-making rules apply :
- Voluntary (not co-erced)
- Informed (adequate information)
- The patient must be competent to make it
Why is free will important in doctors determining consent?
- is the patient coming under undue pressure to choose in a certain way?
- is there anything that makes this patient particularly vulnerable to coercion?
Is consent always necessary?
There are some situations where you cannot get consent, and cannot postpone until you can
- eg. emergency treatment of an unconscious or otherwise incapacitated patient
- eg. urgent mental health treatment under the Mental Health Act
In these situations, you should act in the patient’s best interests.
If you have information about what they would want in this situation (eg. advance directive, or advance statement) then you should use this
